The impact of executive function: Extending the theory of planned behaviour to understand concussion reporting among university athletes

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University of New Brunswick


Research addressing athlete concussion symptom reporting has primarily emphasized symptom recognition and knowledge of return to play (RTP) protocol as outcome variables. However, there is evidence knowledgeable athletes conceal symptoms to continue playing, especially in important games (Kroshus et al., 2020). A health behaviour model, the Theory of Planned Behaviour (TPB), has recently been used to explain concussion reporting based on associated beliefs and attitudes. Only one study (Register-Mihalik, Linnan, et al., 2013), however, has followed the original methodology designed to elicit a comprehensive account of concussion reporting using the TPB and found the TPB accounted for 58% of the variability in reporting behaviour. In the present study, the addition of executive function (EF; the ability to plan, organize, and execute goal-directed behaviour; Lezak et al., 2012) to the model was examined to determine the extent to which EF improved the model’s predictive validity for intentions to report concussion symptoms. Methodological limitations of previous research were addressed by developing and validating a TPB questionnaire (Theory of Planned Behaviour Concussion Reporting Questionnaire [TPB-CRQ]) with university-level athletes (N = 55) prior to testing the extended model. Subsequently, university-level athletes (N = 264) completed an online questionnaire package including measures of concussion reporting (the TPB-CRQ), executive functioning, athletic identity, and symptoms of Attention-Deficit/Hyperactivity Disorder. Hierarchical multiple regression was used to evaluate the extended TPB model and found TPB variables accounted for 35.1% variance in intention to report. While EF did not improve the model, the findings highlighted the importance of context, inaccurate perceived social norms, and a lack of perceived control over reporting as key determinants of intention to report. Based on the findings, suggested modifications to current educational and intervention approaches include integrating the role of context, emphasizing positive consequences for reporting, building reporting self-efficacy, incorporating facilitated team conversations into preseason education, and re-establishing commitment to safety procedures throughout the season to increase attitudes and belief transparency among athletes, coaches, and staff.